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Methodist Hospitals of Dallas · HC MRI Extremity Lwr Joint Woc
$1,463.40
Source file dated 2026-03-21 · both
Source note: OPPS APC; APC Pricing (APC Code: 5523 / Adjusted APC Price: 240.08), and; Pricing Extension - MHS HB PRC CIGNA HEALTHSPRING - Medicare OPPS Outlier; Note: No outlier payment added to this line. Paid as 105% of $240.08 as defined in the pricing extension.; Estimated Allowed Amount: 252.09
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